Pressure to avoid non-essential Caesarean sections is mounting as evidence continues to emerge regarding the long-term health risks1. However, rates of prolonged and obstructed labor remain unchanged2. This makes skills in instrumental delivery crucial for safe delivery and litigation avoidance.
While forceps is sometimes adopted as the sole option for instrumental vaginal delivery, it presents different advantages and disadvantages compared with vacuum3. Vacuum-assisted delivery is the less invasive instrument for correcting a paramedian and/or deflexing presentation, is associated with less maternal morbidity, and is considered the first line method4.
Competence in both forceps and vacuum delivery may become increasingly worthwhile for a third reason. News media has the potential to influence public perception very quickly, as shown in the case of a mother’s call for a ban on forceps5 , which made national headlines in 2018.
It makes sense to have the full skill set. But vacuum-assisted delivery is only a safe and effective option in the hands of a well-trained clinician6,7. When best practice is followed, vacuum-assisted delivery is safe and effective and provides the least maternal risk 8, 9.
Vacca Research (now the Academy) surveyed 115 participants prior to workshops in 2016 and found that knowledge of prevention of subgaleal haemorrhage was low. Two thirds did not know how to prevent it and a quarter would fail to diagnose it, compromising level 1 neonatal surveillance contra to RANZGOG recommendations (C-obs 28: rec 3.5.2).
RANZCOG maintains that ‘the importance of adequate training and supervision in vacuum delivery cannot be over-emphasised’ (2012). Despite strong evidence that inadequate training is a signiﬁcant factor in adverse outcomes, operators are not attaining adequate training prior to performing vacuum deliveries (Vacca 2006, clinical excellence commission 2014).
91% of clinicians in our 2016 survey said they had not been provided adequate training for the prevention of subgaleal haemorrhage. And, in some groups, one third of clinicians said they would perform a vacuum delivery on a 32-week infant, despite this being a serious contraindication for vacuum delivery.